Provider Demographics
NPI:1417129305
Name:GURA, GEORGETTE FERNANDA (CPNP)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:FERNANDA
Last Name:GURA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 SIX FORKS RD
Mailing Address - Street 2:STE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8228
Mailing Address - Country:US
Mailing Address - Phone:919-787-9555
Mailing Address - Fax:919-510-5111
Practice Address - Street 1:5904 SIX FORKS RD
Practice Address - Street 2:STE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8228
Practice Address - Country:US
Practice Address - Phone:919-787-9555
Practice Address - Fax:919-510-5111
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300235363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003676Medicaid